<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />


</head>
<body>

<form>
<table>

<tr>
<td width="75">Tipo </td>
<td width="181">

<input type="radio" name="radio_tipo"/>Pessoa Fisica 
<input type="radio" name="radio_tipo"/>Empresa
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;</td>
<td><label for="centro_custo">C.C</label></td>
<td><input type="text" size="10" name="centro_custo"></td>

</tr>

<tr>
<td>Cliente</td>
<td>
<select name="combo_cliente" id="combo_cliente">
<option value="">----------------------</option>



</select>
</td>
</tr>

<tr>
<td>Veículo</td>
<td>
<select name="combo_veiculo" id="combo_veiculo">
<option value="">----------------------</option>

</select>

</td>

<td width="72">&nbsp;</td>
<td width="172"></td>
</tr>

<tr>
<td>Motorista</td>
<td><input name="text_motorista" type="text" id="text_motorista" value="         "></td>
<td>Telefone</td>
<td><input name="text_telefone" type="text" id="text_telefone"></td>
</tr>




<tr>
<td></td>
<td></td>

</tr>


<tr>
<td>Retirada</td>
<td><input name="text_retirada" type="text" id="text_retirada"></td>
<td>Entrega</td>
<td><input name="text_entrega" type="text" id="text_entrega"></td>
</tr>


<tr>
<td>Valor / Dia</td>
<td><input name="text_valor" type="text" id="text_valor"></td>
<td>Acréscimo</td>
<td><input name="text_acrescimo" type="text" id="text_acrescimo"></td>
</tr>


<tr>
<td>&nbsp;</td>
<td></td>

</tr>

</table>

<table>

<tr>
<td>Observações</td>
</tr>
<tr>
<td><textarea name="text_observacoes" cols="60" rows="8" id="text_observacoes"></textarea></td>
</tr>


<tr>
<td>

<input type="button" value="Sair"></input>

<input type="reset" value="Limpar"></input>

<input type="submit" value="Gravar" src="./images/icon_confirm.png"></input> 
</td>

</tr>

</table>


</form>

<br> <br> <br> <br> <br> <br> 
<br> <br> <br> <br> <br>

</body>
</html>